The information provided here is meant to give you a general idea about each of the medications listed below. Only the most general side effects are included, so ask your doctor if you need to take any special precautions. Use each of these medications as recommended by your doctor, or according to the instructions provided. If you have further questions about usage or side effects, contact your doctor.

Anxiolytics (anti-anxiety medications) and antidepressants can help ease the symptoms of panic disorder. They are often used in combination with counseling. Depending on the person, medication may be advised only for a short time or for a long period of time. Medication helps relieve symptoms but should not take the place of counseling (psychotherapy), which can address the root of the problem.

Prescription Medications

Benzodiazepines

  • Lorazepam (Ativan)
  • Prazepam (Centrax)
  • Flurazepam (Dalmane)
  • Clonazepam (Klonopin)
  • Triazolam (Halcion)
  • Chlordiazepoxide (Librium)
  • Halazepam (Paxipam)
  • Temazepam (Restoril)
  • Oxazepam (Serax)
  • Clorazepate (Tranxene)
  • Diazepam (Valium)
  • Alprazolam (Xanax)

Monoamine Oxidase Inhibitors (MAOIs)

  • Isocarboxid (Marplan)
  • Phenelzine (Nardil)
  • Tranylcypromine (Parnate)

Tricyclic Antidepressants

  • Doxepin (Adapin, Sinequan)
  • Clomipramine (Anafranil)
  • Nortriptyline (Aventyl, Pamelor)
  • Amitriptyline (Elavil)
  • Imipramine (Janimine, Tofranil)
  • Maprotiline (Ludiomil)
  • Desipramine (Norpramin, Pertofrane)
  • Trimipramine (Surmontil)
  • Protriptyline (Vivactil)

Selective Serotonin Reuptake Inhibitors (SSRIs)

  • Citalopram (Celexa)
  • Fluvoxamine (Luvox)
  • Paroxetine (Paxil)
  • Fluoxetine (Prozac)
  • Sertraline (Zoloft)
  • Escitalopram (Lexapro)

FDA Public Health Advisory for Antidepressants

The FDA advises that people taking antidepressants should be closely observed. For some, the medications have been linked to worsening symptoms and suicidal thoughts. These adverse effects are most common in young adults. The effects tend to occur at the beginning of treatment or when there is an increase or decrease in the dose.

Although the warning is for all antidepressants, of most concern are the SSRI class such as:

For more information, please visit: http://www.fda.gov/cder/drug/antidepressants/

Atypical Antidepressants

  • Trazodone (Desyrel)
  • Venlafaxine (Effexor)
  • Nefaxadone (Serzone)

Prescription Medications

Benzodiazepines

Common names include:

Benzodiazepines relieve symptoms of panic disorder by enhancing the function of gamma aminobutyric acid (GABA), a neurotransmitter thought to be abnormal in people with anxiety disorders. These drugs produce a sedative effect, relieve physical symptoms, such as muscle tension, and often cause drowsiness and lethargy. The advantage of benzodiazepines is that they are fast-acting and useful for treating acute anxiety , panic, and insomnia . When stopping the medication, you should slowly taper off over a period of weeks or months under a doctor’s supervision.

These drugs can be habit-forming when used long-term or in excess, in which case they may cause withdrawal symptoms such as “rebound panic,” anxiety, irritability, and insomnia when discontinued. If you have previously had a problem with substance abuse ( alcoholism , drug addiction ), discuss with your doctor whether or not you should use benzodiazepines.

Do not take benzodiazepines with alcohol or other sedating drugs. Do not take if you must drive a vehicle or operate equipment. These drugs should not be taken in combination with certain oral antifungal medications or by people with certain types of glaucoma .

Possible side effects include:

  • Drowsiness or lethargy
  • Dizziness, particularly in elderly persons
  • Confusion
  • Impaired coordination
  • Slow reaction time

Monoamine Oxidase Inhibitors (MAOIs)

Common names include:

Monoamine oxidase inhibitors (MAOIs) are a type of antidepressant that relieve symptoms of panic disorder by preventing the breakdown of serotonin and noradrenaline. They are especially effective for people whose symptoms have not responded to other treatments. Improvement is usually seen in 2-6 weeks after beginning treatment. MAOIs are not addictive.

MAOIs can cause adverse reactions when combined with many other types of drugs, such as:

  • Other types of MAOIs
  • Antidepressants
  • Sympathomimetics
  • Sedatives
  • Narcotics
  • Anesthetics
  • Antihypertensive drugs
  • Diuretics
  • Antihistamines
  • Buspirone
  • Dexfenfluramine
  • Dextromethorphan

Ask your doctor and pharmacist for a complete list of what to avoid.

At minimum, a 2-5 week break is necessary between stopping MAOIs and starting another antidepressant. MAOIs can cause birth defects and should not be taken by pregnant women.

When taking MAOIs, you should not eat food with a high tyramine content, such as:

  • Cheese
  • Alcohol
  • Pickled, marinated, smoked, cured, or fermented foods
  • Organ meats
  • Nuts and peanut butter
  • Fava beans
  • Onions
  • Avocados
  • Canned figs
  • Chocolate
  • Caffeine
  • Foods containing monosodium glutamate (MSG)

Possible side effects include:

  • Changes in blood pressure, including hypertensive crisis
  • Weight gain
  • Reduced sexual response
  • Insomnia

Tricyclic Antidepressants

Common names include:

Tricyclic antidepressants regulate the neurotransmitters serotonin and/or noradrenalin in the brain. Tricyclic antidepressants are not addictive.

Possible side effects include:

  • Dizziness
  • Dry mouth
  • Constipation
  • Difficulty urinating
  • Weight gain
  • Low blood pressure
  • Sexual dysfunction

Selective Serotonin Reuptake Inhibitors (SSRIs)

*** See note above.

Common names include:

Selective serotonin reuptake inhibitors (SSRIs) affect the concentration of the neurotransmitter serotonin, which plays a role in anxiety. Although they are considered antidepressants, SSRIs have been used effectively for the treatment of panic and other anxiety disorders. Improvement is usually seen in 4-6 weeks after beginning treatment. SSRIs are not addictive. Do not take an SSRI if you have taken an MAOI in the last 2-5 weeks.

Possible side effects include:

  • Nausea
  • Diarrhea
  • Insomnia
  • Loss of appetite or weight loss
  • Nervousness
  • Dizziness
  • Sexual dysfunction (ranging from decreased arousal to erectile dysfunction and/or delayed time to orgasm)

Atypical Antidepressants

Common brand names include:

Atypical antidepressants affect the concentration of the neurotransmitter serotonin and can be effective in treating panic. Improvement is usually seen in 4-6 weeks after beginning treatment.

Possible side effects include:

  • Nausea
  • Nervousness
  • Diminished sex drive

Special Considerations

Consultation with a specially trained mental health professional is recommended if you do not respond to treatment with medications. A mental health professional can help clarify the diagnosis and determine if another psychiatric disorder is present. He can also make recommendations about psychotherapy and changes in medications.

If you are taking medications, follow these general guidelines:

  • Take your medication as directed. Do not change the amount or the schedule.
  • Do not stop taking them without talking to your doctor.
  • Do not share them.
  • Know what the results and side effects. Report them to your doctor.
  • Some drugs can be dangerous when mixed. Talk to a doctor or pharmacist if you are taking more than one drug. This includes over-the-counter medication and herb or dietary supplements.
  • Plan ahead for refills so you don’t run out.

When to Contact Your Doctor

Contact your doctor if you have any side effects that are troublesome and persistent or if you have any questions about your medications.